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Tang KWK, Millar BC, Moore JE. Improving health literacy of antibiotic use in people with cystic fibrosis (CF)-comparison of the readability of patient information leaflets (PILs) from the EU, USA and UK of 23 CF-related antibiotics used in the treatment of CF respiratory infections. JAC Antimicrob Resist 2023; 5:dlad129. [PMID: 38046567 PMCID: PMC10691746 DOI: 10.1093/jacamr/dlad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023] Open
Abstract
Background Antibiotic adherence is poor amongst people with cystic fibrosis (CF). Low-quality patient information leaflets (PILs), which accompany prescription antibiotics, with poor readability may contribute to poor antibiotic adherence, with the potential for antimicrobial resistance (AMR) development. The aim of this study was to examine the readability of antibiotic PILs used to treat CF lung infections. Methods CF-related antibiotics (n = 23; seven classes: aminoglycosides, β-lactams, fluoroquinolones, macrolides/lincosamides, oxazolidinones, tetracyclines, trimethoprim/sulfamethoxazole) were investigated. Readability of PILs (n = 141; 23 antibiotics) from the EU (n = 40), USA (n = 42) and UK (n = 59) was calculated. Results Mean [± standard error of mean (SEM)] values for the Flesch Reading Ease (FRE) for EU, USA and UK were 50.0 ± 1.1, 56.2 ± 1.3 and 51.7 ± 1.1, respectively (FRE target ≥60). Mean (± SEM) values for the Flesch Kinkaid Grade Level (FKGL) for the EU, USA and UK were 9.0 ± 0.2, 7.5 ± 0.2 and 9.6 ± 0.2, respectively (FKGL target ≤8). US PILs were significantly shorter (P < 0.0001) in words (mean ± SEM = 1365 ± 52), than either UK or EU PILs, with fewer sentences (P < 0.0001), fewer words per sentence (P < 0.0001) and fewer syllables per word. The mean ( ± SEM) reading time of UK PILs (n = 59) was 12.7 ± 0.55 mins . Conclusions Readability of antibiotic PILs is poor. Improving PIL readability may lead to improved health literacy, which may translate to increased antibiotic adherence and AMR avoidance. Authors preparing written materials for the lay/patient CF community are encouraged to employ readability calculators, so that final materials are within recommended readability reference parameters, to support the health (antibiotic) literacy of their readers.
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Affiliation(s)
- Ka Wah Kelly Tang
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
| | - Beverley C Millar
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD Northern Ireland, UK
- Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
| | - John E Moore
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD Northern Ireland, UK
- Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
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Dawson S, Rodham K, Taylor J, Dewar J, Wildman M. "I think most people feel like healthcare professionals tell them to take their treatments and judge them for not taking them": reflexive thematic analysis of the views of adults with cystic fibrosis on how treatment adherence is discussed in healthcare. Psychol Health 2023:1-23. [PMID: 37667520 DOI: 10.1080/08870446.2023.2254318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Previous research exploring patient-practitioner communication in relation to adherence in cystic fibrosis (CF) is limited. This UK study explored the views of adults with CF on how treatment adherence (related to all CF treatments) is discussed in routine CF care. METHODS 12 White British adults (ten females; aged 20-37 years; mean 30.1 years) with CF participated in semi-structured interviews. RESULTS Three overarching themes were developed through reflexive thematic analysis: (1) 'The power of language'; (2) 'Healthcare professionals do not recognise the importance of context'; and (3) '"Admitting" non-adherence is difficult'. The way in which adherence is discussed in adult CF care is viewed as paternalistic and infantilising. Participants reported that healthcare professionals do not always consider the desire to balance treatment-taking with living a normal life. Unwelcome responses from healthcare professionals, and the inability to accurately self-report the amount of treatment taken made it difficult to 'admit' non-adherence. CONCLUSIONS A culture change is needed in CF care such that people who struggle to take their treatments are not labelled as disobedient, wilfully disobeying orders from healthcare professionals in positions of authority. Instead, an open, honest, non-judgemental approach, as recommended by healthcare agencies for over a decade, should be adopted.
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Affiliation(s)
- Sophie Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Karen Rodham
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
- Institute of Psychology, Business and Human Sciences, University of Chichester, Chichester, UK
| | - Jennifer Taylor
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Jane Dewar
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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3
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Morrison L, Thornton CS. Quality over quantity: the next ACT in airway clearance in cystic fibrosis. Eur Respir J 2023; 62:2301354. [PMID: 37690789 DOI: 10.1183/13993003.01354-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Lisa Morrison
- Queen Elizabeth University Hospital (The Southern General Hospital), West of Scotland Adult CF Unit, Glasgow, UK
| | - Christina S Thornton
- Division of Respirology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Calthorpe RJ, Goodchild N, Gleetus V, Premakumar V, Hayee B, Elliott Z, Evans B, Rowbotham NJ, Carr SB, Barr H, Horsley A, Peckham D, Smyth AR. A grumbling concern: an international survey of gastrointestinal symptoms in cystic fibrosis in the modulator era. NIHR OPEN RESEARCH 2023; 3:18. [PMID: 37881465 PMCID: PMC10593346 DOI: 10.3310/nihropenres.13384.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 10/27/2023]
Abstract
Background Gastrointestinal symptoms in cystic fibrosis (CF) are common and intrusive to daily life. Relieving gastrointestinal symptoms was identified as an important research priority and previously explored in an international survey in 2018. However, following the widespread introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators in 2019, the landscape of CF treatment has changed. We repeated an online survey to further describe gastrointestinal symptoms and their effect on quality of life (QoL) in the CFTR modulator era. Methods An electronic survey consisting of closed questions and free text responses was distributed via social media and professional networks for a period of one month between March - April 2022. People with CF (pwCF), their family and friends, and healthcare professionals (HCPs) were invited to take part. Results There were 164 respondents: 88 pwCF (54%), 22 (13%) family, and 54 (33%) healthcare professionals (HCPs). A total of 89/110 (81%) pwCF or family members reported CFTR modulator treatment. The most commonly reported symptoms were wind / gas, rumbling stomach noises, loose motions (modulator) and bloating (no modulator). Abdominal pain and bloating had the greatest impact on QoL.For those on a CFTR modulator, the proportion of pwCF reporting "no change" or "worse" for all of the symptoms surveyed was greater than the proportion reporting an improvement. Following modulator introduction, dietary changes were recommended by 28/35 (80%) of HCPs and reported by 38/76 (50%) lay respondents. Changes in medication were recommended by 19/35 (54%) HCPs and reported by 44/76 (58%) of patients and family members. Conclusion This survey has shown that gastrointestinal symptoms remain prevalent in pwCF in the CFTR modulator era, though the nature of these symptoms may have changed. A better understanding of the underlying pathophysiology of these symptoms is essential. Future clinical studies should focus on improving symptoms and QoL.
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Affiliation(s)
- Rebecca J Calthorpe
- University of Nottingham School of Medicine & NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | | | - Vigilius Gleetus
- University of Nottingham School of Medicine & NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Vinishaa Premakumar
- University of Nottingham School of Medicine & NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Bu Hayee
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | | | - Nicola J Rowbotham
- University of Nottingham School of Medicine & NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Siobhán B Carr
- Royal Brompton Hospital (part of GSTT) and Imperial College, London, UK
| | - Helen Barr
- University of Nottingham School of Medicine & NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alexander Horsley
- University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Daniel Peckham
- Leeds Institute of Medical Research at St James’s, Leeds, UK
| | - Alan R Smyth
- University of Nottingham School of Medicine & NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Abstract
Exercise and airway clearance techniques (ACTs) have been a cornerstone of treatment for people with cystic fibrosis (pwCF) for many decades. Exercise may confer both respiratory and nonrespiratory benefits for pwCF, with greater exercise capacity associated with improved survival. A wide variety of exercise interventions for pwCF have been investigated. ACTs may assist in reducing respiratory symptoms for pwCF and are currently recommended to be performed daily, with the types of ACTs used varying globally. While recommended components of care, both exercise and ACTs are time-intensive and maintaining adherence to the recommendations over the longer term can be challenging. It has been proposed that with advances in the therapeutic options for pwCF, a rationalization of the therapeutic regimen may be possible. We summarize the current evidence for the use of exercise and ACTs by pwCF, discuss the implications of the introduction of cystic fibrosis transmembrane conductance regulator modulators on both exercise and ACTs, and highlight areas for further research.
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Smith S, Calthorpe R, Herbert S, Smyth AR. Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 2:CD013733. [PMID: 36734528 PMCID: PMC9896904 DOI: 10.1002/14651858.cd013733.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Improved understanding and treatment of cystic fibrosis (CF) has led to longer life expectancy, which is accompanied by an increasingly complex regimen of treatments. Suboptimal adherence to the treatment plan, in the context of respiratory disease, has been found to be associated with poorer health outcomes. With digital technology being more accessible, it can be used to monitor adherence to inhaled therapies via chipped nebulisers, mobile phone apps and web-based platforms. This technology can allow monitoring of adherence as well as clinical outcomes, and allow feedback to both the person with CF and their healthcare team. OBJECTIVES To assess the effects of using digital technology to monitor adherence to inhaled therapies and health status in adults and children with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 28 October 2021. We also searched Embase and three clinical trial registries and checked references of included studies. Date of last search: 9 November 2021. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) looking at the effects of a digital technology for monitoring adherence of children and adults with CF to inhaled therapies. DATA COLLECTION AND ANALYSIS Two review authors screened the search results for studies eligible for inclusion in the review and extracted their data. We used Risk of Bias 2 for assessing study quality. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS We included two studies in our review, with 628 participants aged five to 41 years. There was one study each for two different comparisons. Nebuliser target inhalation mode versus standard inhalation mode The included parallel study was carried out over 10 weeks after a run-in period of four to six weeks. The study compared the effects of a digitally enhanced inhalation mode (target inhalation mode) for nebulised antibiotics compared to standard mode in children attending a regional CF clinic in the United Kingdom. The study's primary outcome was the time taken to complete the inhaled treatment, but investigators also reported on adherence to therapy. The results showed that there may be an improvement in adherence with the target inhalation mode when this intervention is used (mean difference (MD) 24.0%, 95% confidence interval (CI) 2.95 to 45.05; low-certainty evidence). The target inhalation mode may make little or no difference to forced expiratory volume in one second (FEV1) % predicted (MD 1.00 % predicted, 95% CI -9.37 to 11.37; low-certainty evidence). The study did not report on treatment burden, quality of life (QoL) or pulmonary exacerbations. eNebuliser with digital support versus eNebuliser without support One large multicentre RCT monitored adherence via data-tracking nebulisers. The intervention group also receiving access to an online web-based platform, CFHealthHub, which offered tailored, flexible support from the study interventionist as well as access to their adherence data, educational and problem-solving information throughout the 12-month trial period. We graded all evidence as moderate certainty. Compared to usual care, the digital intervention probably improves adherence to inhaled therapy (MD 18%, 95% CI 12.90 to 23.10); probably leads to slightly reduced treatment burden (MD 5.1, 95% CI 1.79 to 8.41); and may lead to slightly improved FEV1 % predicted (MD 3.70, 95% CI -0.23 to 7.63). There is probably little or no difference in the incidence of pulmonary exacerbations or QoL between the two groups. AUTHORS' CONCLUSIONS Digital monitoring plus tailored support via an online platform probably improves adherence to inhaled therapies and reduces treatment burden (but without a corresponding change in QoL) in the medium term (low- and moderate-certainty evidence). In a shorter time frame, technological enhancement of inhaling antibiotics may improve adherence to treatment (low-certainty evidence). There may be little or no effect on lung function with either intervention, and online monitoring probably makes no difference to pulmonary exacerbations. Future research should assess the effect of digital technology on adherence in both children and adults. Consideration of adherence to the total treatment regimen is also important, as an improvement in adherence to inhaled therapies could come at the cost of adherence to other parts of the treatment regimen.
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Affiliation(s)
- Sherie Smith
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sophie Herbert
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan R Smyth
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Cave L, Milnes LJ, McHugh GA. Self-care support of diet and the gut in the routine care of
school-age children with long-term conditions: An integrative
review. J Child Health Care 2022; 26:668-682. [PMID: 34190624 PMCID: PMC9667094 DOI: 10.1177/13674935211029124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is policy impetus for provision of self-care support (SCS) for children with long-term conditions (LTCs). However, it is not clear what SCS should consist of and how it can be delivered in routine care. This review aimed to synthesise the literature, specifically on SCS of diet and the gut as these components are essential for optimal growth and development and enhanced quality of life. Using an integrative review methodology, studies conducted between January 1990 and July 2020 were systematically identified and methodological quality assessed using the Mixed Methods Appraisal Tool. Twenty-five studies were included. SCS of diet and the gut consisted of support in developing and applying specific knowledge and skills and practical help with incorporating the demands of self-care into everyday life. Key requisites for models of SCS in the context of delivery and uptake in routine care were starting early, keeping it going, being flexible and choosing appropriate outcomes. This review contributes new understanding on the provision of SCS of diet and the gut for school-age children with LTCs, including identification of gaps in the literature and further research needs.
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Affiliation(s)
- Laurie Cave
- School of Healthcare, University of Leeds, Leeds, UK,Children’s Nutrition and Dietetics, Leeds Teaching Hospitals NHS
Trust, Leeds, UK,Laurie Cave, School of Healthcare, Baines
Wing, University of Leeds, Leeds LS2 9JT, UK.
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8
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Manika K, Hatziagorou E, Kotoulas SC, Kyrvasili SS, Sourla E, Kouroukli E, Sionidou M, Papadaki E, Tsanakas J. Adherence to inhaled therapies over 4 years in people with cystic fibrosis. Pediatr Pulmonol 2022; 57:956-964. [PMID: 35040288 DOI: 10.1002/ppul.25834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study examined the drug-specific and overall adherence of teenagers and adults with cystic fibrosis (CF) to inhaled therapies, to assess the degree of adherence, stability over a period of 4 years, and its association with health outcomes. METHODS Fifty-five participants (30 women and 25 men) aged 14 years or older from two CF centers were enrolled in a retrospective review of inhaled medication adherence over 4 years. Adherence was assessed by the number of doses that were obtained by each participant based on the "e-prescription.gr" platform and the calculation of the medication possession ratio (MPR). RESULTS The mean composite MPR (cMPR) for the entire research period was 0.75 ± 0.19. A total of 43.4% of participants showed a variance of adherence <25%. Participants with stable adherence had a significantly higher mean cMPR compared with those with variable adherence (0.86 ± 0.16 vs. 0.66 ± 0.17, p < 0.001). A statistically significant difference between groups of patients with different degrees of mean cMPR and mean weight was observed (p = 0.011). Patients with a mean cMPR ≥0.80 weighed significantly more than those with moderate and low adherence. In addition, mean weight correlated significantly with the mean cMPR (Β [95% confidence interval] = 14.845 [0.191-29.498], r = 0.269, p = 0.047). CONCLUSIONS In our setting, the cMPR was easy to assess and showed that adherence was probably better than expected. The association of cMPR with weight should be further investigated. Stable adherence seemed to be related to high adherence. This observation could enhance our understanding of people with CF and their approach to treatment.
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Affiliation(s)
- Katerina Manika
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - Elpis Hatziagorou
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Serafeim-Chrysovalantis Kotoulas
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - Syrmo-Styliani Kyrvasili
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdokia Sourla
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - Eleana Kouroukli
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Sionidou
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - Eleni Papadaki
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - John Tsanakas
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tornincasa V, Dixon D, Le Masne Q, Martin B, Arnaud L, van Dommelen P, Koledova E. Integrated Digital Health Solutions in the Management of Growth Disorders in Pediatric Patients Receiving Growth Hormone Therapy: A Retrospective Analysis. Front Endocrinol (Lausanne) 2022; 13:882192. [PMID: 35846336 PMCID: PMC9281444 DOI: 10.3389/fendo.2022.882192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/06/2022] [Indexed: 01/31/2023] Open
Abstract
Digital health has seen rapid advancements over the last few years in helping patients and their healthcare professionals better manage treatment for a variety of illnesses, including growth hormone (GH) therapy for growth disorders in children and adolescents. For children and adolescents requiring such therapy, as well as for their parents, the treatment is longitudinal and often involves daily injections plus close progress monitoring; a sometimes daunting task when young children are involved. Here, we describe our experience in offering devices and digital health tools to support GH therapy across some 40 countries. We also discuss how this ecosystem of care has evolved over the years based on learnings and advances in technology. Finally, we offer a glimpse of future planned enhancements and directions for digital health to play a bigger role in better managing conditions treated with GH therapy, as well as model development for adherence prediction. The continued aim of these technologies is to improve clinical decision making and support for GH-treated patients, leading to better outcomes.
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Affiliation(s)
| | - David Dixon
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Quentin Le Masne
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Blaine Martin
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Lilian Arnaud
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Paula van Dommelen
- Department of Child Health, The Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
| | - Ekaterina Koledova
- Global Medical Affairs Cardiometabolic & Endocrinology, Merck Healthcare KGaA, Darmstadt, Germany
- *Correspondence: Ekaterina Koledova,
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Rodkjær L, Jeppesen M, Schougaard L. Management of Cystic Fibrosis during COVID-19: Patient Reported Outcomes based remote follow-up among CF patients in Denmark - A feasibility study. J Cyst Fibros 2021; 21:e106-e112. [PMID: 34785157 PMCID: PMC8590607 DOI: 10.1016/j.jcf.2021.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/08/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022]
Abstract
Background Patients with cystic fibrosis (CF) are considered to be a COVID-19 risk group. In March 2020, a fast-track Patient Reported Outcome (PRO) solution was developed to ensure access to CF care without in-person hospital visits. This study investigated the feasibility of urgently replacing in-person appointments with remote monitoring using telephone consultations combined with PROs. We investigated patients and health care professionals' (HCPs) acceptance, recruitment rate, response rate, missing data, and attrition. Methods We included adult CF patients from the Department of Infectious Diseases at Aarhus University Hospital, Denmark between April and June 2020. Patients filled in a disease-specific questionnaire including relevant clinical aspects, performed home spirometry, and sent in a sputum sample before a scheduled telephone consultation. Twelve participants who completed the questionnaire and had a telephone consultation were interviewed. Three physicians and three nurses from the CF clinical team participated in a focus group interview. Results Eighty patients were recruited for remote monitoring, and 41 patients filled in at least one questionnaire. Overall, both patients and HCPs found remote monitoring and use of PROs acceptable and useful. Patients experienced greater flexibility and found the questionnaire relevant and understandable but pointed out the need for items regarding mental health status and more adequate information about changes in follow-up and workflow. Conclusion Urgent reorganization of outpatient follow-up among CF patients due to COVID-19 was feasible in routine clinical practice. However, patient involvement should be a future point of attention to ensure a sustainable telehealth PRO solution.
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Affiliation(s)
- Lotte Rodkjær
- Department of Infectious Diseases, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Research Centre for Patient Involvement, Aarhus University, Central Denmark Region, Denmark.
| | - Majbritt Jeppesen
- Department of Infectious Diseases, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Liv Schougaard
- Department of Clinical Medicine, Aarhus University, Denmark; Research Centre for Patient Involvement, Aarhus University, Central Denmark Region, Denmark; AmbuFlex, Center for Patient-reported Outcomes, Regional Hospital West Jutland, Herning, Denmark.
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11
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Schultz A. Adherence to CF treatment can be improved with the right approach! Thorax 2021; 77:428. [PMID: 34686569 DOI: 10.1136/thoraxjnl-2021-218134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/04/2022]
Affiliation(s)
- André Schultz
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia .,Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
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12
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Telehealth after the pandemic: Will the inverse care law apply? (Commentary). J Cyst Fibros 2021; 20 Suppl 3:47-48. [PMID: 34521596 PMCID: PMC8433501 DOI: 10.1016/j.jcf.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic has accelerated the use of telehealth within the cystic fibrosis (CF) community to deliver CF care. The article by Solomon and colleagues exploring the patient and family experiences of telehealth care delivery, as part of the CF chronic care model in the US, is therefore timely. In this commentary, we discuss how the US experience of telehealth care compares with reports from CF centres in other parts of the world. We highlight the potential challenges, including whether the inverse care law will apply in this new era of CF telehealth.
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Opportunities and pitfalls of social media research in rare genetic diseases: a systematic review. Genet Med 2021; 23:2250-2259. [PMID: 34282302 DOI: 10.1038/s41436-021-01273-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Social media may be particularly valuable in research in rare genetic diseases because of the low numbers of patients and the rare disease community's robust online presence. The goal of this systematic review was to understand how social media is currently used in rare disease research and the characteristics of the participants in these studies. METHODS We conducted a systematic review of six databases to identify studies published in English between January 2004 and November 2020, of which 120 met inclusion criteria. RESULTS Most studies were observational (n = 114, 95.0%) and cross-sectional (n = 107, 89.2%), and more than half (n = 69, 57.5%) utilized only surveys. Only 101 rare diseases were included across all studies. Participant demographics, when reported, were predominantly female (70.1% ± 22.5%) and white (85.0% ± 11.0%) adult patients and caregivers. CONCLUSION Despite its potential benefits in rare disease research, the use of social media is still methodologically limited and the participants reached may not be representative of the rare disease population by gender, race, age, or rare disease type. As scholars explore using social media for rare disease research, careful attention should be paid to representativeness when studying this diverse patient community.
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Coucke R, Chansard A, Bontemps V, Grenet D, Hubert D, Martin C, Lammertyn E, Bardin E, Bulteel V, Chedevergne F, Bourgeois ML, Burgel PR, Honore I, de Keyser H, Kirszenbaum M, de Carli P, Sermet-Gaudelus I, Hayes K. "Il faut continuer à poser des questions" patient reported outcome measures in cystic fibrosis: An anthropological perspective. J Cyst Fibros 2021; 20:e108-e113. [PMID: 33648900 DOI: 10.1016/j.jcf.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with cystic fibrosis (pwCF) are central in the development of patient-led assessment tools. Qualitative analysis of a frequently used CF-specific patient-reported outcome measure (PROM) sought patient recommendations for development of a new quality of life (QoL) tool. METHODS We performed an inventory of PROMs, symptom-report and QoL tools used in clinical trials within the European Cystic Fibrosis Society Clinical Trial Network (ECFS-CTN) and in routine clinical practice among Cystic Fibrosis Europe and ECFS members. A qualitative study using cognitive interviews with pwCF and their caregivers reviewed the Cystic Fibrosis Questionnaire (CFQ), the French initial form of the Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS Survey results from 33 countries revealed over 70 tools used in routine clinical practice, utilized by clinical specialists (n=124), pwCF/parents/carers (n=49) and other allied health professionals (n=60). The CFQ-R was the main PROM used in clinical trials. The qualitative study enrolled 99 pwCF, 6 to 11 years (n=31); 12 to 18 years (n=38); >18 years (n=30) and 26 parents. Inductive thematic analysis based on the CFQ, revealed 19 key themes. Themes common across all cohorts included burden of treatment, impact of disease on day-to-day life, relationships/family, stress/mood, and nutrition. Themes unique to individual groups included, treatment when not symptomatic for the paediatric group; education/studies and planning for the future for adolescents, impact of anxiety and depression on day-to-day life for adults, and for parents, questions addressing anxiety and their role as carers. CONCLUSIONS Patient-centeredness is paramount in development of an up-to-date PROM in the era of novel therapies.
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Affiliation(s)
- Rosa Coucke
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | | | - Véronique Bontemps
- Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux, Campus Condorcet, Bâtiment Recherche Sud, 5 cours de Humanitiés, 93322 Aubervillers cedex, France
| | | | - Dominique Hubert
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Clémence Martin
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | | | | | - Frédérique Chedevergne
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Muriel Le Bourgeois
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Pierre-Régis Burgel
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Isabelle Honore
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | - Maya Kirszenbaum
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Paola de Carli
- Association Vaincre la Mucoviscidose, 181 rue de Tolbiac, 75013 Paris, France
| | - Isabelle Sermet-Gaudelus
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Kate Hayes
- European Cystic Fibrosis Society, Karup, Denmark; Northern Ireland Clinical Research Facility, The Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Ireland.
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